Ⅰ类切口管理软件应用前后手术预防用药的合理性比较

Comparison of rationality of prophylactic antibacterial agents in perioperative period before and after using management software of typeⅠincision

目的:为加强围手术期预防性应用抗菌药物管理,通过信息手段干预Ⅰ类切口手术预防用药,开发"Ⅰ类切口手术抗菌药物管理系统",并评价其干预的有效性,为医院抗菌药物管理提供方法学参考。方法:按卫计委相关文件的要求,设计Ⅰ类切口手术围手术期抗菌药物使用控制流程,开发"Ⅰ类切口手术抗菌药物管理系统",并嵌入医院HIS,对Ⅰ类切口手术抗菌药物预防使用的指证、品种选择、给药时机、预防用药疗程等作了具体限制。采用回顾性方法对我院2014年第一季度(软件应用前)与2015年第一季度(软件应用后)3个科室(骨科、神经外科、心血管外科)的Ⅰ类切口手术预防用药的各项指标进行统计,分析实施干预前后Ⅰ类切口围手术期抗菌药物使用情况。结果:软件应用后(干预后)3个科室的Ⅰ类切口手术预防使用抗菌药物的比率显著下降(P<0.01),由软件应用前(干预前)的84.08%(169/201)降至干预后的56.52%(117/207);药物选择合理率有了显著提高(P<0.01),由干预前的48.52%(82/169)提高到了82.91%(97/117);术后疗程合理率显著提高(P<0.01),从干预前的55.03%(93/169)提高到了95.73%(112/117)。对给药时机及单次给药剂量无影响。结论:临床药师通过"Ⅰ类切口手术抗菌药物管理系统"参与Ⅰ类切口围手术期抗菌药物预防应用管理,使得Ⅰ类切口手术不合理使用抗菌药物的现象明显改善,该管理软件设计合理,操作方便,成效显著。

OBJECTIVE To strengthen perioperative prophylactic antibacterials,intervene preventive medication for typeⅠincision by means of information technology,and jointly develop＂antibacterial drug management system for typeⅠincision operation＂and evaluate effectiveness of intervention,provide a methodological reference for management of antibiotics in hospitals.METHODS According to requirements of related guidance documents issued by Ministry of Health,control flow for perioperative antibacterial drugs was designed for type Ⅰincision operation,＂application program for antibacterial drug management for type I incision operation＂was developed,which was embedded in hospital information system（HIS）.The program had specific limitations on indications of antibiotics,choice of antibiotics,time of administration and course of preventive antibiotics in Ⅰincision operation.By using retrospective method,prophylactic application rate of antibacterials and qualified rate of suitable drug selection,medication time,course of postoperative prevention,single dose of antibacterial agents for preventive usage etc.of type Ⅰ incision preventive medication during the first quarter of 2014（control group）and 2015（intervention group）in3 departments,including orthopedics,neurosurgery and cardiovascular,were taken into account for statistical analysis.RESULTS After the intervention,prophylactic application rate of antibacterials in type Ⅰ incision surgery in 3 departments was significantly decreased（P〈0.01）,from84.08%（169/201）to 56.52%（117/207）.Reasonable rate of drug selection had improved significantly（P〈0.01）,from48.52%（82/169）to 82.91%（97/117）.Reasonable rate of prophylactic course was increased significantly（P〈0.01）,from55.03%（93/169）to 95.73%（112/117）.CONCLUSION Through ＂antibacterial drug management system for type I incision operation＂,clinical pharmacists have participated in antibacterial drug clinical application management,and significantly improved rational use of antimicrobial agents in type Ⅰ incision operation.This study has shown that the program is designed reasonably and has obviously promoted rational application of antibacterial drugs.